风湿性疾病患者并发类固醇糖尿病诊断要点及其相关风险因素的探讨

Discussion on the Clinical Diagnose of Steroid-Induced Diabetes Mellitus and the Related Risk Factors in Patients with Rheumatic Disease

目的研究接受大剂量类固醇治疗的风湿性疾病患者并发类固醇性糖尿病(steroid diabetes mellitus,SDM)的比例以及相关风险因素。方法本研究是回顾性研究,选取住院接受类固醇治疗的风湿性疾病患者55例,均在早餐后口服30~60 mg/d强的松龙,并持续超过2周。以每餐前与餐后2 h 6个时间点血糖浓度作为SDM诊断依据,按是否患有SDM而将之分为SDM组33例及非SDM组22例。同时比较两组患者年龄、体质量指数、强的松龙累计用药剂量以及每天用药量、疗程及血清胆固醇和甘油三酯浓度。结果 SDM组午餐后2 h血糖浓度都大于或等于11.1 mmol/L,平均值为13.1 mmol/L。午餐后2 h的血糖浓度检测敏感度被认为100%。SDM组在每个测量点的血糖浓度高于非SDM组(P<0.01)。SDM组平均年龄明显高于非SDM组(P<0.05),接受强的松龙治疗后的胆固醇浓度亦明显高于非SDM组(P<0.05)。两组间体质量指数、强的松龙累计用药剂量以及每天用药量、疗程、甘油三酯浓度差异无统计学意义(P>0.05)。结论午餐后2 h监控血糖浓度可以有效地检测SDM,且午餐后高血糖浓度、高龄及高血胆固醇与风湿性疾病患者SDM的发生密切相关。

Objective To study the frequency of steroid-induced diabetes mellitus （SDM） and the related risk factors in patients with rheumatic disease who receive high doses of steroids. Methods A retrospective study was used for 55 patients with rheumatic disease treated in our hospital. The patients were orally taken prednisolone 30-60 mg/day after breakfast and the therapy course was for more than 2 weeks. Glucose concentrations （hereafter Glu）, as the SDM diagnostic basis, were detected for 6 times in each day, i.e. immediately before and 2 hours after each meal. The patients were assigned into two groups： SDM group （33 patients） and non-SDM group （22 patients）. Meanwhile their ages, body mass indexes, duration of therapy, cumulative total and daily doses of prednisolone, triglyceride concentrations and serum cholesterol between two groups were compared. Results The concentration of 2-hour blood glucose after lunch of SDM group was greater than or equal to 11.1 mmol/L, the average 13.1mmol/L. The detection sensitivity of 2-hour glucose after lunch was 100%. Glucose at each time point in SDM group was higher than that in non-SDM group in each detection （P〈0.01）. The mean age in SDM group was significantly higher than that in non-SDM group （P〈0.05）. Cholesterol concentration of patients after treated with prednisolone in SDM group was significantly than that in non-SDM group （P〈0.05）. The body mass indexes, cumulative total and daily doses of prednisolone, and triglyceride between two groups were not statistically different （P〉0.05） Conclusion The detection of 2-hour glucose after lunch is effective to diagnose SDM in patients with rheumatic disease. High postprandial hyperglycemia, high age, and high hypercholesterolemia are closely related to the occurrence of SDM in rheumatic patients